Qualitative research methods and mental health

I have argued a number of times in various forums that mental health research needs to maintain sight of the individual person who experiences mental disorder (Shepherd, A. (2013). The need for inclusion of concepts of recovery in clinical trials. The British journal of psychiatry : the journal of mental science, 202(2), 153–153. doi:10.1192/bjp.202.2.153). I don’t mean to argue that there is no place for population level epidemiology, treatment or neuroimaging – simply that we must ensure that individual experience, phenomenology, is maintained at the core of our research. I do have some concerns regarding efforts to identify those at “high risk” for psychosis (Reilly, T. J., & McGuire, P. K. (2013). Translating neuroimaging findings into psychiatric practice. The British Journal of Psychiatry, 203(6), 397–398. doi:10.1192/bjp.bp.113.130005) but that is a different argument. 

I think that the best way to ensure that we avoid losing sight of individual experience is to incorporate qualitative measures in a longitudinal fashion in other forms of research, for example clinical trials. This, in my opinion, offers us the best means of paralleling the clinical techniques, used day-to-day in mental health clinics for assessment, in research. In this light I thought I would describe two recent books that I read that I think provide an excellent example to qualitative research methods, with insight as to how they could be applied in mental health research. Of note, neither of these books is written specifically for an audience of mental health researchers, they are more general in their approach to the methodology – the first is written by two anthropologists, the second by two criminologists.

 

Coffey and Atkinson – Making sense of qualitative data

This book appears to be aimed primarily at postgraduate researchers beginning to use qualitative techniques in their research projects. A typical reader suggested by the authors is one who has completed a volume of field work and is now presented with a monumental task of “analysis” of various transcripts and other information sources.

The book presents its material in seven chapters; Introduction, Coding, Narrative, Meaning and Metaphor, Writing and representation, Beyond the Data and Computer aided strategies. This final chapter, as is the nature of such chapters, suffers obviously from the book being nearly 10 years old. General points made continue to resonate – for example ensuring that technology supports the research process and doesn’t define it, but the specific software examples become somewhat redundant. 

The authors argue for a methodological approach that is not driven by one particular technique, but instead seeks to explore the nature of the object of study through appropriate complementary strategies. So, for example, the thematic analysis and coding of transcripts is presented as being a necessary technique in reducing data to manageable chunks and sections – a cautionary note is sounded in the second chapter however to avoid losing sight of the overarching nature of the material. 

I found this message of avoiding losing sight of bigger pictures and prevention of becoming bogged down in methodological niceties to be pertinent to the current state of mental health research. The complementary approach to research to allow the best approach possible to me was also salutary.

 

Doing qualitative research differently – Holloway and Jefferson

 In this second book the authors, two criminologists researching the nature of peoples’ fear of crime, discuss their findings and methods incorporating psychodynamic theory into qualitative research. They seek to contrast the idea of a research participant “telling it like it is” with their description of a “defended subject”. 

Their overarching thesis parallels that of Coffey and Atkinson, that we must avoid losing sight of detailed narrative information in our efforts to represent findings. The authors present a technique in which detailed biographical information is gathered relating to research participants, in their example using multiple sources through corroboratory interviews. The actual interview is conducted in a free manner – such that the participant brings information that they feel relevant to the discussion and are not dictated to by the researcher. Reflective notes are recorded following interview, describing the feelings elicited in the researcher during the meeting. These parallel sources of information are combined in order to allow exploration of research findings.

I found this book quite heartening and the parallel with mental health practice, obvious given the inspiration for the method, is striking. The message of considering the participants autobiography and how this affects their representation of events and interview conduct seems particularly relevant to my own research. 

 

Summary

I hoped in this post to address an aspect of much modern clinical mental health research that I find frustrating and to describe two books that I feel provide research descriptions and techniques that could be invaluable if incorporated into psychiatric research practice. Oliver Sacks, at the beginning of the fantastic “The man who mistook his wife for a hat”, bemoans the demise of the physician who could represent the experiences of patients through narrative – best represented by the, now minimally published, case reports that used to fill academic journals. Sacks’ interest is the experience of those with neurological disorder and while many psychiatrists now style themselves as neuropsychiatrists, and it has been argued that this represents the future of the psychiatric profession, I think that we could stand to reflect a little more on the impact of Sacks’ writing on public discourse and his reflections on the nature of medical practice and research.

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